Section Behavioral health problems are among the most prevalent of health problems in the United States and are directly related to poor healthcare quality and higher utilization of healthcare services. Despite the fact that a solid body of evidence shows that primary care settings offer abundant opportunities for early identification, intervention, and treatment, behavioral health care is not routinely integrated into primary care. The goal of this initiative is to increase the identification and treatment of behavioral health problems by integrating behavioral health services into routine primary care with two evidence-based approaches: Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy substance use and Improvement Mood-Promoting Access to Collaborative Treatment (IMPACT) for depression. The initiative establishes a unique, multi-state partnership that includes three CVEs with extensive experience implementing SBIRT and/or IMPACT: the Pittsburgh Regional Health Initiative (also the lead applicant), the Institute for Clinical Systems Improvement, and the Wisconsin Collaborative for Healthcare Quality. It builds on the collective experience of these partners to develop an Implementation Strategy that addresses both system and practice-level barriers to widespread implementation via best practice approaches and tools in the form of Marketing and Practice Support Plans that contain reimbursement strategies, tools to improve community awareness of the prevalence and impact of untreated behavioral health problems, solutions for workforce training and practice workflow challenges, and guidance on securing and using appropriate health information technology. Importantly, with leadership and support from the initiative's fourth partner, the Network for Regional Healthcare Improvement, the initiative will launch the Implementation Strategy to increase the number of primary care practices implementing SBIRT and/or IMPACT in primary care settings via a phased, three-year implementation plan, first encompassing primary care practices in MN, WI and PA, followed by practices recruited by 5 CVEs or regional health improvement collaboratives (RHICs) targeted by NRHI, followed by a broader NRHI-led dissemination aimed at further recruitment via 20 additional CVEs or RHICs. Thus, the aim is to increase the number of patients screening positive for depression and/or unhealthy substance use who receive appropriate follow-up care and experience a reduction in symptoms. PUBLIC HEALTH RELEVANCE: The research initiative, which is being organized by three CVEs and the Network for Regional Healthcare Improvement, targets depression and substance use, which affects 17.6 million2 and 22 million16 Americans, respectively. The goal is to identify unhealthy substance use and depression in the primary care setting before these chronic diseases become debilitating by removing barriers and introducing strategies, training, and tools to widely disseminate and implement comparative effectiveness research-based models that integrate behavioral health services into primary care-Screening, Brief Intervention, and Referral to Treatment (SBIRT) and Improvement Mood-Promoting Access to Collaborative Treatment (IMPACT). Identifying and managing these behavioral health conditions is critical for increasing physical and social role function, for improving the ability to manage co-morbid physical diseases,5,67,8,15 for reducing the economic costs of untreated behavior health problems,9 and for reducing the current and large treatment gap for people with substance use disorders.13